By Gift Briton
The number of children dying before their fifth birthday is projected to rise globally for the first time this century. As such, countries have been urged to prioritise primary health care (PHC) as the best investment amid shrinking global health budgets.
The 2025 Goalkeepers Report, released by The Gates Foundation and based on data analysis by the Institute for Health Metrics and Evaluation (IHME), shows that 4.6 million young children died in 2024. The number is expected to increase by more than 200,000 this year, reaching an estimated 4.8 million.
This surge comes at a moment when global development assistance for health has dropped 26.9 percent below 2024 levels, leaving countries with fewer resources to combat preventable diseases such as pneumonia, diarrhoea, malaria, and complications at birth.
“We can still save millions of lives. But with millions of lives on the line, we have to do more with less, now, “writes Bill Gates, chair of the Gates Foundation.
If current funding cuts persist, IHME projections show that 12 million additional children could die by 2045. If cuts deepen to 30 percent, an estimated 16 million additional deaths are projected.
Gates calls this moment a critical turning point, one that demands sharper priorities, clearer focus, and investments that deliver the greatest impact.
And at the centre of the report is a simple, evidence-backed argument: Strong PHC systems are the world’s best bet for saving the most lives with the least money.
Strong PHC systems, community clinics, frontline health workers, routine check-ups, maternal care, and early detection can prevent up to 90 percent of child deaths for less than $100 per person per year. The authors argue that no other investment produces such a consistent and wide-reaching impact.
The report shows that when governments prioritise PHC, they build the foundation for all other health gains: safe pregnancies, timely births, newborn survival, nutrition support, routine immunisation, and early detection of illnesses.
For families in rural and low-income communities, PHC often provides the only accessible and affordable care. Without these systems, diseases that could be treated early become fatal.
Vaccines, delivered through strong PHC networks, remain one of the most powerful life-saving tools. According to the report, every $1 spent on immunisation returns $54 in economic and social benefits. Gavi, the Vaccine Alliance, has helped immunise more than 1.2 billion children since 2000.
Similarly, the Global Fund to Fight AIDS, Tuberculosis, and Malaria has saved 70 million lives and reduced deaths from these diseases by more than 60 percent.
Beyond strengthening PHC, the report identifies next-generation innovations that could dramatically reduce child mortality if properly funded, including pneumonia vaccines, new malaria tools and vaccines, and long-acting HIV prevention such as lenacapavir.
Gates warns that without investment in these technologies, the world risks having “the most advanced science in human history” yet failing to deliver it to the children who need it most.
The Goalkeepers Report spotlights frontline health workers, local leaders, and scientists who continue delivering lifesaving care despite financial and systemic constraints.
In Nigeria’s Gombe State, Governor Muhammad Inuwa Yahaya prioritised primary healthcare and education, even during a severe budget deficit. “You don’t need perfect conditions to make progress,” he writes. “You need clarity and the courage to stick to it.”
In Kenya, community health worker Josephine Barasa continued serving mothers and children after her paid position was cut.
“They could take away the money, but they couldn’t take me away from my women,” she says, highlighting the dedication of frontline workers who sustain health systems even when resources fade.
In Uganda, entomologist Krystal Mwesiga Birungi is pioneering next-generation tools for malaria control. “Ending malaria is not only possible, but it is also urgent,” she notes. “We African researchers know this, and we are leading the way.”
Gates urges governments, philanthropies, multilateral organisations, and citizens to protect existing health budgets and direct them to the interventions that save the most lives.
“We can’t stop at almost,” he writes. “If we do more with less now, then in 20 years we’ll be able to tell a different story: how we helped more kids survive childhood.”
